Human immunodeficiency virus infection and chemotherapy treatment in the Kingdom of Bahrain

Human immunodeficiency virus (HIV) is a lentivirus which that may progress to immunodeficiency syndrome (AIDS) and predispose for opportunistic infections and malignancies. According to recent reports,  1.5 million people died of AIDS in 2013 worldwide which is a 35% decrease since 2005. The number of deaths has decreased in part due to antiretroviral treatment (ART) wide spread use. In Bahrain, in 2011, a multidisciplinary team was established for HIV management involving major stakeholders: public health, infectious diseases, pharmacists, nursing and virologists. A retrospective descriptive study is done about HIV positive patient in Bahrain, their current treatment regimens and other blood parameters were collected, aiming to have a general idea about their health status in a way to help in their medical care. The data was collected retrospectively from the 2014 registry about all patients who are diagnosed to have HIV. Their ART regimen, CD 4 count and viral load were gathered and entered in Excel sheet.. A total of 208 patients were diagnosed to have HIV up to 2014. However, only 108 of them have their full data. In addition, a review of the frequency of admission of these patients over a 10 year period was done too. On reviewing the medical records of the patients admitted over the last ten years from 2004 till 2014, it was found that the total admission of HIV positive patients were 107. Hepatitis C was the most common co infection among those patients with a percentage of 24%. It was found that with better ART treatment and better structure of HIV team and program, we are getting more patients to be controlled. There is a clear increase in the number of patients with improving CD4 count. Based on the results of our study, the HIV multi-disciplinary management team is an essential part for the best management of these patients

Promoting cross-regional collaboration in antimicrobial stewardship: Findings of an infectious diseases working group survey in Arab countries of the Middle East.

Abstract Background Antimicrobial resistance is a significant global issue that presents an increasing threat to patients' wellbeing. Although a global concern, the emergence of multi-drug resistant organisms is of particular significance in the Middle East. In recent years, this region has seen an alarming increase in antimicrobial resistance presenting a major challenge to physicians managing various infectious diseases. Methods A Working Group comprising experts in infectious diseases from Arab countries of Middle East assembled to review similarities and differences in antimicrobial practices and management of multi-drug resistant organisms across the region and assess the barriers to achieving cross-regional collaboration. The Working Group conducted an anonymous online survey to evaluate current practice and understanding of management of multi-drug resistant organisms across the region. Results A total of 122 physicians from Arab countries of the Middle East responded to the survey. Their responses demonstrated heterogeneity between countries in awareness of local epidemiology, management of multi-drug resistant organisms and antimicrobial stewardship practices. The Working Group recognized similarities and differences in the management of multi-drug resistant organisms across the region, and these were validated by the data collected in the survey. Overall, the similarities across the region reflect several key issues that can have an impact on the management of multi-drug resistant organisms and the prevention of antimicrobial resistance. Conclusions This paper highlights the urgency of addressing antimicrobial resistance in Arab countries of the Middle East. The Working Group identified key barriers to effective management which may guide the development of future coherent strategies to promote effective antimicrobial stewardship in the region. Here, we outline a call to action for the region, with a need to focus on training and education, capacity building, infrastructure, regional research, and regional surveillance

Infection among renal transplant patients in the Kingdom of Bahrain: A ten year retrospective study ( 2004-2014)

Introduction:  Kidney transplantation is the process of transplanting the organ to a patient with end stage renal disease. Complications with transplant can be encountered during or for a varying period post operatively. As graft survival and immunosuppressant regimens have improved, infection of grafts have become a leading concern. The diagnosis of infection in such patients is challenging too due to the lack of the typical infection indicators like fever as the patients are immunocompromised. The focus of our study is to study the extent of infection on the transplanted patients. The research will look into the type of microorganisms encountered, their management and outcome. Methods  & Materials: A retrospective study was carried out between the periods of 1st of January 2004 to 31st of December of the same year 2014. All renal transplant patients admitted during this period were segregated according to the reason of admission. Only those with impression of infection were enrolled.   Results: A total of 108 patients admitted between the period of 1st of January 2004 and 31st of December 2014 with impression of infection post renal transplant. Some of the patients had recurrent history during those ten years for infectious purposes. From the 108 patients, 74 of them received transplant from living donors (68.52%). The diagnosis on admission was limited to certain differentials. 35.19% patients were admitted with the impression of urinary tract infection. Pneumonia was diagnosed in 10.19%.  patients.  Majority of patient (89.96%) were on maintenance dose of steroids. That was followed by MMF, Tacrolimus and cyclosporine with a percentage of 81.48%, 46.3% and 25.93% respectively. Regarding the antibiotics, 86.11% of the admitted patient were started on single antibiotic on admission including those with recurrent admission. Conclusion: Fever is a common presenting symptom in our population of transplant recipients which reflects the possibility of infection. The majority responded to a single antibiotic use.  The limitation of our study is the small number of the transplanted patients. &nbsp

Patterns of antibiotic prescriptions and appropriateness in the emergency room in a major secondary care hospital in Bahrain

Objective: To describe the pattern and appropriateness of antibiotics prescribed in the emergency room in a major secondary care hospital in Bahrain.Methods: Patients aged more than or equal to 14 years old that attended emergency room and was prescribed antibiotics from 1 to 31 July 2014 were included. Data were obtained from patients’ emergency records. Antibiotic treatment was classified to appropriate, inappropriate or unjustified use according to the local or international guidelines. Chi Square was performed to evaluate the variables associated to appropriateness antibiotic treatment.Results: A total of 1313 patients were included (52.6% males), mostly in the age group 14-30 years old (45.3%). The most frequent diseases attended were upper respiratory and urinary tract infections (27.3% and 22.1%,respectively). Cefuroxime was the most prescribed antibiotic (37.5%) followed by ciprofloxacin (20.8%). Percentage of inappropriate antibiotics prescription was 81.9% mostly due to unjustified use. Inappropriate antibiotic treatment was significantly more common in males (87.1%; P-value <0.001), in patients without mentioned diagnosis, then upper respiratory tract infection (100%, 96.9%. P-value <0.001) and prescriptions written by emergency physicians (85.5%; P- value <0.001).Conclusion: The study concludes that high rate of inappropriate antibiotics use mostly among patients treated by emergency doctors

Tetanus in an unvaccinated laborer in Bahrain

Summary: Mr. M.D.S., a 27-year-old Indian male, presented with complaints of diffuse body pain and spasms, 7 days after a needle penetrated his right foot at his place of work. He was diagnosed clinically with tetanus. The patient was electively intubated to protect the airway and transferred to an intensive care unit. In addition to his tetanus, he developed multiple hospital-acquired infections. After 34 days, he was successfully extubated and extensive physiotherapy commenced. He was discharged 10 days after extubation. Keywords: Tetanus, Infection, Occupation, Vaccination, Antibiotic

Evaluation of an adjusted MEWS (Modified Early Warning Score) for COVID-19 patients to identify risk of ICU admission or death in the Kingdom of Bahrain

Background: While most COVID-19 cases have uncomplicated infection, a small proportion has the potential to develop life-threatening disease, as such development of a prediction tool using patients baseline characteristics at the time of diagnosis should aid in early identification of high-risk groups and devise pertinent management. Hence, we set up this retrospective study to determine preadmission triaging tool to predict the development of severe COVID-19 in the Kingdom of Bahrain Materials and methods: A retrospective study was conducted from 1 September 2020 to 30 November 2020 with enrolment of all SARS-CoV-2 PCR-confirmed persons aged ≥ 14 years who attended Al-Shamil Field Hospital (SFH) in the Kingdom of Bahrain for triaging and assessment with recording of the following parameters: systolic blood pressure, heart rate, respiratory rate, temperature, the alert, verbal, pain, unresponsive neurological score, age, oxygen saturation, comorbidities, Body Mass Index (BMI), duration of symptoms and living with immunocompromised populations to develop our local adjusted MEWS as predictor for ICU admission & for consideration of suitable isolation at home.Follow up data of all patients was obtained from the electronic medical records system including CXR findings, treatments/medications received, need of oxygen supplements /intubation, needs of ICU care, and the outcome (death /discharged alive)IBM SPSS statistic version 21 program was used for data analysis. Results: Our study showed that using the locally developed adjusted MEWS score, there was an significant association between high value of this adjusted MEWS score and abnormal radiographic finding (49.7 % Vs. 17 % for patients with high score Vs. those with low score respectively). Out of the 181 patients with high scores on adjusted MEWS; 38.7 % required oxygen via nasal cannula, 14.4 % required face mask and 8.3 % non-rebreather mask; this proportion was significantly higher than their counterpart patients who score low on adjusted MEWS (20.9 %, 7.7 %, 4.8 %respectively) with statistically significance difference between the two groups (p value of 0.00, 0.00,.004 respectively)Requirement of ICU admission was significantly higher among patients with high score in comparison to those with low score (14.4 % vs. 3 %) with significant p value (0.00)But higher score value was not associated significantly with increase mortality rate among COVID patients. Conclusion: Development of our new Adjusted MEWS score system by adding the additional elements of age, oxygen saturation, comorbidities, Body Mass Index (BMI) and duration of symptoms found to be very useful predictor tool for preadmission triaging of COVID patients based on their risk assessment to help clinician to decide on the appropriate placement to different level of isolation facilities

Clinical practice guidelines for the management of invasive Candida infections in adults in the Middle East region: Expert panel recommendations

Invasive Candida infections contribute to significant morbidity and mortality in patients with healthcare-associated infections. They represent a major burden on the public health system, and are challenging to diagnose and treat.A multidisciplinary expert panel critically reviewed available evidence to provide consensus recommendations for the management of invasive Candida infections in the Middle East.Based on diagnosis, recommendations were provided for the management of Candida infections in non-neutropenic and neutropenic patients. Polyenes (amphotericin B-deoxycholate [AmB-d] and lipid formulations amphotericin B [LFAmB]), triazoles (fluconazole, itraconazole and voriconazole), echinocandins (caspofungin, anidulafungin, and micafungin) and flucytosine are the recommended categories of antifungal agents for treatment of Candida infections. Echinocandins are preferred for treatment of proven and suspected Candida infections, especially in critically ill patients or those with previous exposure to azoles. Recommendations were also provided for infections caused by specific Candida species as well as management of different disease conditions.The experts highlighted that the guidelines should be used along with clinical judgment. Given the paucity of published data from the region, research in the form of randomized clinical trials should be given priority. Keywords: Candida, Treatment, Guidelines, Candidiasis, Middle Eas